Patient Education and Care for Peritoneal Dialysis Catheter Placement: A Quality Improvement Study

Abstract

ORIgINAL ARTICLES♦ Background and Objectives: Peritoneal dialysis catheter (PDC) complications are an important barrier to peritoneal dialysis (PD) utilization. Practice guidelines for PDC placement exist, but it is unknown if these recommendations are followed. We performed a quality improvement study to investigate this issue. ♦ Methods: A prospective observational study involving 46 new patients at a regional US PD center was performed in collaboration with a nephrology fellowship program. Patients completed a questionnaire derived from the International Society for Peritoneal Dialysis (ISPD) catheter guidelines and were followed for early complications. ♦ Results: Approximately 30% of patients reported not being evaluated for hernias, not being asked to visualize their exit site, or not receiving catheter location marking before placement. After insertion, 20% of patients reported not being given instructions for follow-up care, and 46% reported not being taught the warning signs of PDC infection. Directions to manage constipation (57%), immobilize the PDC (68%), or leave the dressing undisturbed (61%) after insertion were not consistently reported. Nearly 40% of patients reported that their PDC education was inadequate. In 41% of patients, a complication developed, with 30% of patients experiencing a catheter or exit-site problem, 11% developing infection, 13% needing PDC revision, and 11% requiring unplanned transfer to hemodialysis because of catheterrelated problems.♦ Conclusions: There were numerous deviations from the ISPD guidelines for PDC placement in the community. Patient satisfaction with education was suboptimal, and complications were frequent. Improving patient education and care coordination for PDC placement were identified as specific quality improvement needs. Perit Dial Int

ISPD Catheter-Related Infection Recommendations: 2017 Update

“…The method of training is often believed to affect the risk of catheter-related infections (79,80). An observational study found that the rate of ESI was reduced 10-fold with a program that incorporated intensive training of nursing staff and patients, improved operative aseptic technique and reduction in S. aureus nasal carriage (81).…”

Urgent-Start Peritoneal Dialysis: A Chance for a New Beginning

“…31 Coordination of care also is challenged when PD nurses do not feel comfortable questioning operator practices. 31 To address these issues, the nephrologist must help educate the operator about best practices and ensure implementation of standardized care protocols. Such protocols should emphasize patient education and communication with dialysis caregivers.…”

“…There should be a clear algorithm reflecting operator responsibilities and a periodic audit of quality metrics. 31 …”

“…13 Nephrologist-led advocacy with operators and hospitals can foster the use of best practices to reduce the number of complications encountered by the PD nurse. 31 …”

Dancing around Elephants

“…Ultimately, those fellows will become the committed nephrologists who tackle the infrastructure barriers by promoting surgical and nursing expertise. This deficiency has been well documented (8,9) and recently re-emphasized (2,3). Competency in PD is determined at the local level by the training program director.…”